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4. Is routine female hormone testing necessary?

TL;DR: Hormone testing is generally only necessary if you have menstrual irregularities, fertility issues, specific symptoms, or if your doctor recommends it. Routine hormone testing is not required.

Research: At present, none of the clinical guidelines recommend routine hormone testing for women. As expected, there are no randomized controlled trials on this particular subject. One case study1 states that unnecessary hormone testing may lead to over-interpretation or misleading results.

Doc’s Opinion: Hormone testing is typically advisable in the following situations:

  • You have irregular menstrual cycles

  • You are facing fertility issues

  • You have symptoms of hormonal imbalances

Remember to always consult a doctor before you take any hormone tests.

What We Know

What are female hormone tests?

A complete female hormone panel checks the levels of a wide range of hormones in the body that regulate puberty, menstruation, reproduction, pregnancy, menopause, and overall well-being. These include:

  • Estrogen

  • Progesterone

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH)

  • Prolactin

  • Testosterone

  • DHEAS

  • Thyroid hormones

  • Anti-Müllerian hormone (AMH)

A few additional tests may be combined along with hormone testing, such as:

  • Insulin resistance testing (fasting insulin, fasting glucose, HbA1c, HOMA-IR)

  • Vitamin and mineral tests (iron profile, Vitamin B12, Vitamin D)

What do hormone test results mean?

​In a hormone levels test, the healthcare provider will take your blood sample and send it to the lab for analysis. It is a quick, low-risk, and simple blood test that can help with:

  • Diagnosis of health conditions such as polycystic ovary syndrome (PCOS), thyroid disease, and diabetes

  • Checking your reproductive health and determining the underlying causes of your fertility problems

  • Assessing if you are entering perimenopause or menopause

  • Monitoring whether a specific medication or hormone replacement therapy is working

When do you typically need hormone blood tests?

You mainly need a comprehensive women’s hormone test panel in the following two situations:

  • You have irregular periods

  • You are having trouble getting pregnant

  • Irregular periods2: Menstrual cycle length less than 21 days or more than 35 days, accompanied by too little or heavy blood flow

  • Infertility3: No pregnancy after 12 months of unprotected sex in women below 35 years or within 6 months in women above 35 years.

You may also need specific hormone tests if you have certain hormone imbalance symptoms.

Note: The symptoms discussed in the table below may have other multiple causes apart from hormonal imbalances. So, if you are facing any of them, discuss them with your doctor for appropriate advice.

Symptoms
What might this mean
What tests you may need

Fatigue, cold intolerance, and unexplained weight gain

Thyroid imbalance4

Thyroid-stimulating hormone (TSH), Free T4, anti-TPO antibodies

Acne, hirsutism, and scalp hair thinning

Androgen imbalance5

Total/free testosterone, DHEAS

Mood swings and PMS-like symptoms

Estrogen-progesterone imbalance

Day 21 estrogen and progesterone test, thyroid profile

Abnormal nipple discharge and irregular periods

Prolactin6 and thyroid imbalance

Prolactin, TSH

Hot flashes, irregular sleep, vaginal dryness, and concentration or memory issues7

Estrogen-progesterone-FSH/LH imbalance

Follicle stimulating hormone (FSH), estradiol, thyroid profile

Unexplained weight gain, central obesity, and sugar cravings

Insulin resistance8

Fasting insulin and glucose, HbA1c, HOMA-IR

Persistent fatigue, weakness, dizziness, and a lack of motivation

Vitamin and mineral deficiency9

Vitamin B12, vitamin D, iron profile

References

  1. Smellie WS. Cases in primary care laboratory medicine: testing pitfalls and summary of guidance on sex hormone testing. BMj. 2007 Jan 11;334(7584):91-4.

  2. Attia GM, Alharbi OA, Aljohani RM. The impact of irregular menstruation on health: a review of the literature. Cureus. 2023 Nov 20;15(11).

  3. Walker MH, Tobler KJ. Female infertility. StatPearls [Internet]. 2022 Dec 19.

  4. Peter N Taylor, Marco M Medici, Alicja Hubalewska-Dydejczyk, Kristien Boelaert. Hypothyroidism. The Lancet, Volume 404, Issue 10460, 2024, Pages 1347-1364, ISSN 0140-6736.

  5. Vittorio E. Bianchi, Elena Bresciani, Ramona Meanti, Laura Rizzi, Robert J. Omeljaniuk, Antonio Torsello. The role of androgens in women's health and wellbeing. Pharmacological Research, Volume 171, 2021, 105758, ISSN 1043-6618.

  6. Al-Chalabi M, Bass AN, Alsalman I. Physiology, prolactin [Internet]. StatPearls - NCBI Bookshelf. 2023.

  7. Peacock K, Carlson K, Ketvertis KM, Doerr C. Menopause (Nursing). StatPearls [Internet]. 2023 Dec 21.

  8. Freeman AM, Pennings N. Insulin resistance. StatPearls [Internet]. 2023 Aug 17.

  9. Kiani AK, Dhuli K, Donato K, Aquilanti B, Velluti V, Matera G, Iaconelli A, Connelly ST, Bellinato F, Gisondi P, Bertelli M. Main nutritional deficiencies. Journal of preventive medicine and hygiene. 2022 Oct 17;63(2 Suppl 3):E93.

Vaibhavi Kodnani

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